bloating

Doctors Lisa and Sara talk to Locum Consultant Dr Caitriona MacDermott about assessing and managing constipation in Palliative Patients. A common symptom with a significant impact on people’s quality of life, the episode aims to get across the importance of the topic, the often multifactorial nature of clinical scenarios, the red flags not to miss and arm you with a logical and holistic approach to management. We discuss how management might differ for patients with certain conditions such as partial bowel obstruction, neurological causes, or liver disease. An important listen for those of us in the community looking after palliative patients. 
 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
 
Useful resources: 
Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf
Clinical Knowledge Summaries from NICE: Palliative Care - Constipation (Updated Feb 2024): https://cks.nice.org.uk/topics/palliative-care-constipation/
NICE CKS Table of Doses of Laxatives that can be used for Palliative Patients: https://cks.nice.org.uk/topics/palliative-care-constipation/prescribing-information/doses-of-laxatives/
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: [email protected]
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This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024***
To get in touch: [email protected]
Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios. This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions.
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf
Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/
Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf
Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/
Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf
An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file
Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/
Resource for help reducing and stopping medications: https://medstopper.com/
Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/
Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full
Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793
Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/
Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: [email protected]
___
This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to GP Dr Charlotte Bădescu about Ovarian Cancer. We focus on the important learning points about cardinal and other features of presentations to better understand this cancer as an abdominal cancer with symptoms that can and do often present much earlier than the diagnosis is often picked up. She talks us through the value of CA125 tests and the reasons not to be overly reliant on them, though they can be a useful tool in the tool box. The usefulness of ultrasound scans, both pelvic and transvaginal, as well as clinician continuity is discussed.  We go through 2 hypothetical cases based on real examples as well as Charlotte’s own diagnosis. An excellent episode for picking up great learning points to avoid missing this diagnosis in your own patients. 
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: 
NICE Guidelines: Suspected Cancer, Recognition and Referral (Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers
NICE guidelines on Ovarian Cancer (Published April 2011): https://www.nice.org.uk/guidance/cg122
GP network & resources: https://targetovariancancer.org.uk/health-professionals/GPs
Nurses network & resources: https://targetovariancancer.org.uk/health-professionals/nurses
Patient resources: https://targetovariancancer.org.uk/support-for-you
Shine Cancer Support: https://shinecancersupport.org/
ForteenFish Free Ovarian Cancer Webinar (you will need to log-on and search Ovarian Cancer): https://www.fourteenfish.com/
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Originally recorded in January 2020 and released in August 2020...
Early diagnosis of cancer is a huge priority in order to try to improve our cancer survival rates in the UK. Lisa and Sara took the opportunity to speak to Dr Sarah Taylor, GP in Fallowfield and Cancer Research UK Cancer Diagnosis Lead for Greater Manchester about this important subject.
It was recorded pre-Covid-19 and so some of the information given about services might have changed in your local area. We thought the general tips about picking up cancer as early as possible were incredibly useful however which is why we decided to release the episode. 
We cover why early diagnosis of cancer is a priority for the UK, learning points/common themes picked up from significant events in delayed cancer diagnosis, tools that we can use in primary care to help our pick up rate and useful resources for primary care.
Useful resources: 
Gateway C: https://www.gatewayc.org.uk/
Cancer Research UK Health Professional Section: https://www.cancerresearchuk.org/health-professional
Macmillan Health Professional Resources: https://www.macmillan.org.uk/about-us/health-professionals/resources
QCancer Score: https://www.qcancer.org/
Cancer Research UK Facilitator Programme: https://www.cancerresearchuk.org/health-professional/learning-and-support/about-our-partnerships/what-is-the-facilitator-programme
NICE Suspected cancer - recognition and referral: https://www.nice.org.uk/guidance/ng12
BJGP - Improving early diagnosis of cancer in UK general practice: https://bjgp.org/content/67/659/276
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT
___
This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

We are joined by Paediatric Consultant Dr Christos Zipitis to discuss a great overview of infant feeding issues. It was fabulous to go over definitions, presentations and management of colic, gastro oesophageal reflux and reflux disease, lactose intolerance and cow's milk protein allergy. We later touch on the resource ICON designed to help parents cope with crying babies. Thoroughly worthwhile learning for all the general practice team. 
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The GP Infant Feeding Network (UK): https://gpifn.org.uk/infant-feeding/
Milk Allergy in Primary Care (MAP) Guideline 2019: https://gpifn.org.uk/imap/
GP Online, Feeding Problems in infants (2015): https://www.gponline.com/feeding-problems-infants/paediatrics/paediatrics/article/1377305
Medicines for Children Leaflets: https://www.medicinesforchildren.org.uk
NICE guidelines Food allergy in the under 19s: https://www.nice.org.uk/guidance/cg116
NICE Guidelines Gastro-oesophageal Reflux in children and young people, diagnosis and management: https://www.nice.org.uk/guidance/ng1/chapter/introduction
Thickeners and bowel obstruction discussion reference: Parmar RS et al. Bezoar and bowel obstruction associated with the use of anti-gatro-oesophageal reflux medication in neonates. Infant. 2015; 11(3): 94-5. https://www.infantjournal.co.uk/pdf/inf_063_str.pdf
Discussion on potential side effects of Proton Pump Inhibitors for babies:Cochrane review (2014): Pharmacological treatment of children with gastro‐oesophageal reflux  (see PPI section re possible increased risk of respiratory infections)https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2/full?highlightAbstract=inhibitors%7Cside%7Ceffects%7Cinhibitor%7Ceffect%7Cpump%7Cproton
Long-term PPI use and association with gastric cancer: Ka Shing Cheung and Wei K Leung. Long-term use of PPIs and risk of gastric cancer: a review of the current evidence. Therapeutic Advances in Gastroenterology. 2019; 12: 1-11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415482/
ICON: Resource for parents about how to cope with crying babies: https://iconcope.org/
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We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast
___
This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

The COVID pandemic caused an upheaval to the endoscopy services for suspected upper and lower gastrointestinal malignancies. To talk us through the changes in how referrals are managed and what that means for us in general practice and our patients, we’re joined by GPwSI in Gastroenterology Dr Sophie Nelson and Consultant Gastroenterologist Dr Alistair Makin. Our discussion includes using FIT tests to risk stratify patients with suspected lower GI malignancies, the use of the Edinburgh Dysphagia Scale for suspected upper GI malignancies, a reminder of 2 week wait criteria, and little on iron deficiency anaemia and Helicobacter Pylori. 
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Greater Manchester Gastroenterology Webinar 24th Sept 2020. Speakers: Dr Sophie Nelson, Dr Varinda Athwal (LFTs), Dr Sarah Taylor (FIT testing), Dr Alistair Makin (GI cancers), and Dr May Aldean (advice and guidance) The link includes links to endoscopy pathways. https://gpexcellencegm.org.uk/resources/gm-gastroenterology-gp-education-webinar/#.YEYVCWj7SUk
Guidelines for managing patients with dyspepsia in primary care: https://gpexcellencegm.org.uk/resources/guidelines-for-managing-patients-with-dyspepsia-in-primary-care/#.YFEP4C2l23U 
NICE Gastrointestinal tract (lower) cancers - recognition and referral (Feb 2021): https://cks.nice.org.uk/topics/gastrointestinal-tract-lower-cancers-recognition-referral/
NICE Gastrointestinal tract (upper) cancers - recognition and referral (Feb 2021): https://cks.nice.org.uk/topics/gastrointestinal-tract-upper-cancers-recognition-referral/
Gateway C (an online cancer education platform for primary care): https://www.gatewayc.org.uk/
Greater Manchester Upper and Lower GI Cancer guidelines are available on TeamNet for Manchester clinicians
North West Iron Deficiency Anaemia Guidelines and Coeliac Guidelines: Not yet published but watch out for these soon!
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This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Gastroenterologist Dr Bliss about Irritable Bowel Syndrome. 
***THIS EPISODE HAS BEEN RE-UPLOADED WITH ADDITIONAL INFORMATION ABOUT CA125 BLOOD TESTS***
Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
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This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.